WASTE MANAGEMENT GUIDELINE Prepared by:
Kirklees Infection Control Team
15 August 2007
Dr J Hooper Version No. Approved:
Reference to Standards for Better Health Domain
Department of Health 2004 Standards for Better Health First domain Safety Third domain Governance
Core Standard C4e C7a C7c
Performance indicators 1.To reduce incidence of incorrect segregation of waste
History of Document
Version 1: February 2004 â€“ superseded Version 2: May 2007
CONTENTS Section No. 1 2 3 4 5 6
Page Noâ€™s Introduction Associated Policies and Procedures Duty of Care Accountability European Waste Catalogue Waste Management Definitions and Classifications 6.1 6.2 Hazardous waste 6.3 Medicinal Waste 6.4 Offensive Waste 6.5 Domestic Waste 6.6 Identification of Infectious Waste Table 1 Table 1A Table 2 What are the different types of waste 7.1 Registration 7.2 Controlled Waste Transfer Note 7.3 Waste segregation Documentation Consignment Notes Responsibilities of the production of hazardous/infectious waste away from health premises Classifying Category A and Category B Infectious Waste in the Community 11.1 Category A Infectious waste: Yellow bag 11.2 Category B Infectious waste 11.3 Wounds 11.4 Dressings 11.5 Household waste; black bag 11.6 Offensive waste: yellow/black bags 11.7 Miscellaneous items of waste 11.8 Sharps Storage of Waste/Frequency of Collection Training Personal Protective Equipment & Avoidance of Injury Management of Spillages â€“ Bagged Clinical Waste Management of Sharps Waste Spillages Incidents/Accidents References
8 9 10 11
12 13 14 15 16 17 18 Appendix A Appendix C
1 1 1 2 2 2 2 2 3 4 4 4 5 6 7 8 9 9 9 9 10 10 11 11 11 12 13 13 13 13 14 14 15 15 16 16 16 17
European Waste Catalogue Classification of Medicinal Wastes
NICE Guidance Once NICE guidance is published, health professionals are expected to take it fully into account when exercising their clinical judgement. However, NICE Guidance does not override the individual responsibility of health professionals to make appropriate decisions according to the circumstances of the individual patient in consultation with the patient and/or their guardian or carer.
Introduction The aim of this guideline is to provide guidance on the safe management and disposal of all types of waste within the community including healthcare premises and the home environment. This guidance reflects the Environment Agency, Hazardous Waste Regulations 2005. The Hazardous Waste Regulations 2005 guidance has been produced to provide a framework for good practice on waste management and assist staff who work in NHS Trusts and other producers to meet legislative requirements. The key recommendations are: •
Associated Policies and Procedures • • • • • •
To provide a new system for identifying and classifying hazardous and medicinal wastes that complies with the requirements of three separate regulatory regimes: health and safety legislation, transport and waste regulations. A revised colour coded best practice waste segregation and packaging system. The use of European Waste Catalogue (EWC) codes. Which are mandatory for all waste transfer documentation and ensures that waste is properly segregated into the different waste streams avoiding the mixing of non hazardous from hazardous waste. An offensive waste stream to describe wastes which are non-infectious (human hygiene waste and sanpro waste such as nappies, incontinence pads etc)
PCT Records Management Policy PCT Universal Precautions Guidelines Incident reporting Health and Safety COSHH Hand Decontamination Policy
Duty of Care The statutory requirements covering duty of care in waste management are contained in Section 34 of the Environmental Protection (EPA) Act 1990 and the Environmental Protection (Duty of Care) Regulations 1991. Everyone involved in the management of waste, regardless of the need for a licence or a permit, has a duty of care to ensure that waste is managed appropriately. NHS Trusts have a statutory duty of care that applies to everyone within the waste management chain. It requires the producer / healthcare professional involved in the management of waste to ensure that it is dealt with appropriately from the point of production to the point of disposal. A key requirement is the need for a written description which adequately describes the type and quantity of the waste. This accompanies the waste 1
as it is moved from the point of production to final disposal.
Accountability The Director of Finance is responsible for ensuring effective arrangements for waste management. The risk management operation group and infection control committee will monitor arrangements and provide advice and support to primary care staff.
European Waste Catalogue Recent regulatory changes, require producers to adequately describe their waste using both a written description and the use of the appropriate European Waste Catalogue (EWC) codes(s). The EWC is a list of wastes produced by the European Commission in accordance with the European Waste Framework Directive (75/442/EEC) to provide common terminology for describing waste throughout Europe. The EWC is colour-coded to aid identification of hazardous waste. Absolute entries* (shown in red) in the catalogue are deemed to be hazardous regardless of their composition or concentration. Minor entries (shown in blue) are those which are recognised as having the potential to be hazardous and require an assessment of their composition and concentration. Non-hazardous wastes are shown in black (Appendix A). The EWC categorises waste into 20 chapters; each chapter is linked to a production sector. The main sections for healthcare are chapter 18 and 20. Within each chapter, wastes are described using 6 digit numerical codes, the first two digits of the code relate to the EWC chapter, the second two digits relate to any sub-grouping within the chapter, and the final two digits are unique to the waste
Waste Management Definitions and Classifications 6.1
The definition of clinical waste in the UK is taken from The Controlled Waste Regulations, issued under the Environmental Protection Act. It is defined as: (a) â€œâ€Śany waste which consists wholly or partly of human or animal tissue, blood or other bodily fluids, excretions, drugs or other pharmaceutical products, swabs or dressings, syringes, needles or other sharp instruments, being waste which unless rendered safe may prove hazardous to any person coming into contact with it: and (b) any other waste arising from medical, nursing, dental, veterinary, pharmaceutical or similar practice, investigation, treatment, care, teaching or research, or the collection of blood for transfusion, being waste which may cause infection to any person coming into contact with itâ€?.
Hazardous waste Hazardous waste is waste in categories as defined in the table below. The most common form of waste for health care produced will be waste that is 2
hazardous by infection. The Hazardous Waste Regulations define infectious as : Substances containing viable micro-organisms or their toxins which are known or reliably believed to cause disease in man or other living organisms and may prove hazardous to the environment. It is a legal requirement to segregate non infectious waste from waste that is subject to â€œspecial requirementsâ€? Hazardous waste H1 H2 H3A H3B H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14
Explosive Oxidising Highly Flammable Flammable Irritant Harmful Toxic Carcinogenic Corrosive Infectious Toxic for Reproduction Mutagenic Substances that release toxic gases Substances capable of yielding substances listed above Ecotoxic
Waste defined as clinical waste on the basis of the infection risk, or potential infection risk posed, should be considered hazardous infectious waste as the waste requires specialist treatment/disposal. 6.3
Medicinal Waste Medicinal waste encompasses licensed medicinal products of any type and residuals in bottles, vials and ampoules that are not sharp. Medicinally contaminated syringes, needles and broken glass medicinal ampules are considered to be sharps and need to be disposed of in a sharps bin. Medicinal wastes are listed in both Chapter 18 (Healthcare waste) and Chapter 20 (municiple waste) of the European Waste Catalogue EWC. The EWC differentiates between cytotoxic and cytostatic medicines and all other medicines. Only cytotoxic and cytostatic medicines are considered to be hazardous waste. The term cytotoxic has been in the past referred to medicines which have been associated with the treatment of malignant disease and immunosuppression. These can also be found in chapter 8 of the British National formulary (BNF). Guidance should be sought from the manufacturers of medicinal products with regard to their hazardous properties. The use of data sheets in local pharmacy practices may be used to provide this information. Appendix C Disposal of liquid medicinal waste needs to be separated from solid medicinal waste in separate labelled sharps bins. Diabetic patients who manage their 3
care at home are the exception as they are able to mix both sharps and liquid and solid medicines together.
Offensive waste Offensive waste describes waste which are non-infectious, do not require specialist treatment or disposal but may cause offence to those coming into contact with it. Offensive waste includes wastes previously described as human hygiene waste and Sanpro waste. Examples of offensive waste include sanitary waste, incontinence and other waste produced from human hygiene. Feminine hygiene bins will be provided in all PCT premises for the disposal of offensive waste. Nappies will be placed in a nappy sack, then disposed of as domestic waste.
Domestic Waste Domestic waste should not contain any infectious materials, Sharps or medicinal products. Domestic waste may be placed in black or clear bags for disposal.
Identification of Infectious waste All waste should be assessed on its production. The following simplified assessment has been introduced and is based on the contamination of the waste materials with bodily fluids and is applicable to both wet and dried fluids. The risk assessment should be used to assist and support clinical judgement (See table 1A). A risk assessment should always be carried out on waste contaminated with fluids to determine if the waste is hazardous by infection. The fluids in column 2 do not normally present a risk of infection and wastes contaminated with these fluids will not normally be classified as infectious unless visible blood or the source patient has an infection that might be transmitted via the waste. (See table 2). However, waste contaminated with non infectious bodily fluids (column 2) are capable of causing offence and therefore require appropriate packaging to alert those in the waste management chain of the contents. This has been identified as OFFENSIVE WASTE. However there is no system for pick up within White Rose at present therefore a small amount of nappies or incontinence pad waste (no more than 1 bag of waste per week), as long as there is no known infection, may be placed into domestic waste for Local Authority pick up.
Table 1 Examples of infectious waste generated as a result of healthcare activities.
Column2 Non-Infectious Bodily Fluid
Column 1 Infectious Bodily Fluids
Faeces; Blood; Nasal Secretions; Semen; Sputum; Vaginal Secretions; Tears; Cerebrospinal; Urine; Synovial; Vomit. Pleural; Peritoneal; Pericardial; Amniotic. It should be noted that waste contaminated with the fluids (liquids or dried) listed in Column 2 may be considered infectious if they contain visible blood or there has been a clinical assessment that the source patient has an infection that might be transmitted via the waste. Examples of known infection pathways include: faeces known or suspected to be contaminated with enteric pathogens e.g. Salmonella or Shigella or vomit from a patient assessed to have an acute vomiting virus.
Table 1A Examples of infectious waste generated as a result of healthcare activities Source
Special requirements apply (hazardous by H9)
Special requirements do NOT apply
Clinical (or animal healthcare) waste which has not been subject to specific assessment and segregation protocols to remove waste subject to special requirements.
Non-clinical healthcare waste where the “special requirements” fraction has been removed following item and/or patient specific assessment and segregation
Healthcare premises (hospital, veterinary practice, dentists, nursing homes)
Clinical (or animal healthcare) waste arising from a patient clinically assessed or known to have a disease caused by a micro-organism or its toxin, where the causal pathogen or toxin is present in the waste. For example:
Non-clinical healthcare waste where the “special requirements” fraction has been removed following item and/or patient specific assessment and segregation
Waste from infectious disease cases;
Waste from wound infections and other healthcare-associated infections;
Hygiene products from patients in with UTI infections;
Waste from patients with diarrhoea and vomiting caused by infectious agent or toxins, for example Norwalk and Clostridium difficile;
Blood-contaminated dressings from a patient with HIV, hepatitis B, rubella, measles, mumps, influenza, RSV or other respiratory infections;
Contaminated waste from provision of general healthcare to patients with known or suspected underlying or secondary microbial diseases
Table 2 Assessment and Classification of Hazardous Infectious Waste Is the Waste listed in Chapter 18 of the EWC Yes Is the waste contaminated with bodily fluids
Not infectious Waste
Yes Is the bodily fluid likely to pose a risk of infection? (see column 1 and Column2 bodily fluids table)
Yes Undertake Risk assessment, is risk of infection posed? Yes Infectious Waste
Is the Waste contaminated with a disease causing pathogen or culture on the Category A list for carriage
Infectious Waste (Hazardous Waste Category A)
No Infectious Waste (Hazardous Waste Category B)
What are the different types of waste? The following table provides guidance for the disposal of waste reflecting the guideline and identifies the existing colour coding and the associated classification by White Rose as the contractor and the EWC. This is not exhaustive and further reference should be made to the Environment Agency technical guidance, WM2 which gives guidance on the interpretation, definition and classification of hazardous waste (www.environmentagency.gov.uk/uk/cpmmondata/acrobat/1_haz_waste_intro.pdf )
of Colour European Waste Code
Contents of Waste
Yellow bag with white sticker and no tag. Code 18-01-03
-label bag -Appropriate secure area awaiting collection
Non Hazardous Clinical Waste
Yellow bag with code 18-01-01 Blue Sticker
Licensed/per mitted treatment facility.
General/ domestic waste
Black bag No sticker or code number
No consignment Note. No label. Appropriately secure area awaiting collection.
Amalgam waste from Dental Care Sharps wastes
As defined by contents. Materials contaminated with blood & bodily fluids known to be or believed to be infectious Wastes whose collection and disposal is not subject to special requirements in order to prevent infection e.g. dressings, plaster casts. All types of packaging e.g. dressing packs, boxes, paper towels, newspapers. Small amounts of waste food, uncontaminated Couch roll. These must be appropriately segregated and not disposed of as hazardous waste. Dental Amalgam wastes
Approved container and labelled -sharps container -labelled -Appropriate secure area awaiting collecting
Cytotoxic/ cytostatic Sharps
Colour still to be decided, continue to discard in current sharps bins. Code 18-02-02 Sharps bin â€“ cyto purple tag Code 18 01 08
Hypodermic needles, syringes, scalpels, lancets, giving sets. Any sharp disposable implement.
EU approved container which is leak proof Code 18-01-09 EU approved container Code
Only Cytotoxic and cytostatic medicines including needles and syringes, giving sets.
Hazardous Waste Incineration
Residual medicines/vaccines. Anaesthetic cartridges
-sharps container -labelled Secondary sealed unit -Appropriately stored Container labelled secure area awaiting collection
Residual medicines not in packaging
Waste tablets not in foil pack or bottle
Hazardous waste incineration.
Complete consignment note.
Registered contractor. Do not overfill containers Âž full only.
Registration Sites which are producers of hazardous waste are required to register with the Environment Agency if they produce 200kg or more of hazardous waste per year. Only certain premises that produce less than 200kg of hazardous waste per year are exempt. Therefore all sites as of July 2005 are registered to the Environment Agency and are allocated a site code which is required to complete the consignment notes.
Controlled Waste Transfer Note The annual controlled Waste Transfer note, allows waste to be transferred from one party to another. The Controlled Waste Transfer Note covers all movements of a regular consignment of the same waste between the same parties. A member of staff in each Health Centre must be appointed to be responsible for the controlled Waste Transfer Note and consignment notes.
Waste segregation Segregation of waste at the point of production into colour coded packaging is vital to good waste management. Health and Safety, Carriage and Waste Regulation require that waste is handled, transported and disposed of in a safe and effective manner. A national colour coding system has been suggested, the coding system has not been altered locally, but waste is distinguished by labelling and a consignment note which uses the European Waste Catalogue coding. The colour coding that is contained in the consultation document is reflected in the coloured stickers and tags in circulation.
Documentation The hazardous consignment note will be completed by White Rose Environmental, on collection of the hazardous waste. A copy of the hazardous waste consignment note will be left at the base. It is the responsibility of the locality manager to specify where in the health centre/clinic the copy of the consignment note will be filed. The PCT could be audited by the Environment Agency at any time therefore clinical staff must know where the hazardous waste consignment notes are filed. A copy of the hazardous waste consignment note is to be kept for three years including any other associated paperwork, including contractor returns. Maintaining all consignment notes and correspondence supports waste audit. Audits provide useful information on the composition of waste produced and the results maybe used to identify appropriate re-use or recycling options and opportunities to minimize waste by amending purchasing polices and compliance with regulatory standards. It is the healthcare professionalsâ€™ responsibility following risk assessment to 9
document the identified waste stream in the patients’ notes.
Consignment Notes The layout and content of a Hazardous Waste Consignment Note is specified in the Hazardous Waste Regulations 2005. The waste contractor will assist in the completion of the consignment note. However, the consignor (the practitioner who produces the waste) has a responsibility to ensure the information is correct to ensure the waste stream is compliant and is treated correctly. The waste consignment note requires the following information; • • • •
The European Waste Catalogue Codes A written description of the waste Information about the hazardous nature of the waste and if applicable each hazardous substance (this may involve attaching supplementary sheets to consignment notes) Information about the number of waste containers, colour and size
The monthly return is the responsibility of the contractor. A fee is charged for consignment notes relating to hazardous and non-hazardous waste that can only be treated by high temperature incineration. Waste contractors also have a duty to notify the Environment Agency on a quarterly basis regarding the amount of hazardous waste collected, treated and disposed of. The Environment Agency will then charge the contractor in line with the information that they provide
Responsibilities of the production of hazardous/infectious waste away from health premises Where a patient is treated within their home by a community nurse or other member of the NHS profession, any waste produced is considered to be generated by that healthcare professional and the Duty of Care applies to ensure that the waste is correctly disposed of at an authorised facility. The current position of the PCT is that; •
Following risk assessment if the dressings or other waste can be purchased over the counter and the patient has no known or suspected infection. The waste once bagged appropriately and sealed can be disposed of with household waste with the patients consent.
If the waste is classified as Hazardous by infection the waste can be removed one of two ways; a) The healthcare professional can remove the waste and transport it in an approved UN approved containers (i.e. rigid, leak proof, sealed, secured) and take it back to the trust base for appropriate disposal. b) Via an external contractor arranged by the PCT - Local authority or private waste contractor providing they have gained the consent of the 10
householder to leave it at their home. This arrangement incurs a charge and does not nullify the responsibility of the healthcare professional to segregate accordingly and ensure that legal requirement for the waste to be in a secure place or container is met. The consignment note is completed by the contractor. However, it is the Healthcare professionals’ responsibility to ensure that the waste is removed and that the appropriate documentation is retained for audit purposes. A risk assessment has been performed to ensure there is no risk to the family. •
If a patient self treats in their own home any waste produced is considered to be their own. Where a particular infection risk has been identified (based on medical diagnosis) such waste does need to be treated as hazardous by infection waste. The Local Authority therefore, has a duty to collect the waste separately when asked to do so by the waste holder.
Where visiting a Residential care home where possible use the waste disposal system in place
Classifying Category A and Category B Infectious Waste in the Community
Category A infectious waste: yellow bag It is highly unlikely that the community will produce or see any of the organisms or conditions that are classified as Category A such as Ebola fever, viral haemorrhagic fever, smallpox etc. In the event that a person comes into the country infected with such an organism or develops an infection after travel, the waste that is generated will require double-bagging in yellow bags and packaged accordingly to P620, labelled as Cat A, UN 2814 and collected by a specialist waste company licensed and trained to accept Category A waste. For large waste items that cannot be packaged due to their size (for example mattresses, beds), it is advisable to contact the Department for Transport for advice (in Northern Ireland, the Health & Safety Executive and/or the Department of Enterprise Trade and Industry). If the waste has been generated in the community in the home environment, it should remain where it has been generated until the point of collection. There must be a person attending when the waste is collected. For guidelines concerning specific types of Category A waste, contact either the local public health adviser and/or the Department for Transport.
Category B infectious waste Waste generated in the community should be risk-assessed for hazardous properties, most notably “infectious”. This should be based on professional assessment, clinical signs and symptoms, and any prior knowledge of the patient. 11
The following is a basic and quick assessment of whether the waste contains any infectious fraction. This could be based on the following criteria: 11.3
The following criteria are based on the Delphi process of identity wound infection in six different wound types (European Wound Management Association 2005). Signs and symptoms of inspection
Is there presence of erytherma/cellulites?
Is there presence of pus/abscess?
Is the wound not healing as it should and delayed?
Is the wound inflamed and changed appearance?
Is the wound producing a pungent smell?
Is the wound producing an increase purulent exudates? Has the wound increased in pain?
Increase in skin temperature?
Patient on antibiotics for an infection present in the wound?
Are you thinking of swabbing for infection?
Note It must be recognised that this is not an exhaustive list of signs and symptoms of wound infection and that different types of wound will present differently. This tool is to assist in the basic assessment of all wounds in order to correctly categorise whether the waste produced contains no infectious fraction and therefore infectious waste. Further information and advice regarding assessment of wound infections should be sought from local tissue viability specialist nurse.
Dressings The type of dressings that are produced in the community by the district nurse can vary greatly. Any specialised antimicrobial type of dressing should be automatically disposed of as medicinal (and perhaps infectious) waste. In order to assess whether the dressing is suitable to go into the household black bag, the following should be considered:
the size of the dressing
the quantity produced in one dressing change;
the quantity produced in a week period.
Household waste: black bag Small amounts of dressings typical of what a householder may produce in one dressing change (for example small dressings, packaging, noninfectious bandages, non-infectious gloves) can all be disposed of in the black-bag waste stream. Small dressings would be no larger than a dressing pad, that is 130mm x 220mm. Where the dressings produced equate to more than a quarter of black-bag waste a week, it is advisable to classify all the waste as infectious due to the higher quantity produced and therefore higher perceived risk
Offensive waste: yellow/black bags The most common use of this bag in the household environment will be for such products as incontinence aids etc. However, where the person has a urinary tract or gastrointestinal infection, the pads etc would become infectious waste and require disposing of in an orange bag. It is acceptable to put used empty catheters/catheter bags and stoma bags in to this waste stream.
Miscellaneous items of waste Maggots All maggots used for wound management should be secured in an airtight rigid container and marked as “UN 3291: for incineration only” Wound vacuum drains These should be treated as infectious waste and preferably packaged in the appropriate containment. Stoma bags Where the clinician is involved in the care of the stoma site, the waste from a stoma patient in the house can be disposed of in a black bag – or, if used in bulk, a black-and yellow bag (offensive waste stream). However, if the person develops any type of gastrointestinal infection or the site becomes 13
infected, the bag must be disposed of as infectious waste in an orange bag. If the householder is self-caring, they may dispose of their own waste into a black bag. 11.8
Sharps Sharps boxes should be collected when three-quarters full. If the sharps box is seldom used, it should be collected after a maximum of three months regardless of the filled capacity. Where the healthcare worker generates sharps in the home environment, they must ensure they are disposed of correctly and safely. It is not acceptable for clinicians to mix sharps with non-cytostatic/toxic drugs in one UN-approved container. Any cytostatic or cytotoxic liquid pharmaceutical should be disposed of separately in a rigid leak-proof container. It is acceptable to transport used and partly filled sharps containers in the vehicle of the healthcare worker providing:
they are packaged appropriately
they are in UN-approved containers; and
the healthcare worker agrees that they are willing to transport the waste.
Storage of Waste/Frequency of Collection •
The storage location for hazardous/infectious waste awaiting collection must be secure and lockable and not accessible to the public. Access to these storage facilities should be limited to those responsible for handling, transporting or disposing of waste.
In health centres the yellow bags, when labelled, should be taken to the compound and placed into a suitable dedicated container. At all times where manual handling is involved the necks of the bags should be positioned (tied) to allow subsequent movement to be undertaken safely.
If trolleys and carts are used for the movement of waste within the premises these should be designed and constructed so that the surfaces of the conveyance are smooth and impermeable; they do not offer harbourage to insects, can be easily cleansed and drained and will allow the waste to be handled without difficulty.
Hazardous/infectious waste should be removed as frequently as circumstances demand the collection period should be no less than once a week. Whilst awaiting removal it should be situated in a separate area of adequate size related to the volume of production and frequency of collection, sited on a well drained, impervious hard stand, kept secure from unauthorised persons, domestic animals, birds, rodents and insects and accessible to collection vehicles
Sharps containers are exchanged at regular intervals no more than 14
Staff are required to risk assess any dangers to their own safety and security.
Receptacles/sacks should be replaced at minimum daily or when sacks are ¾ full.
Training Managers have a responsibility to ensure that all staff are trained to handle all types of waste and implement these waste guidelines. All staff who may be required to move bags of hazardous/infectious waste by hand within a particular location should be trained to:• • • • • •
Check that the storage bags are effectively sealed; Handle the bags by the neck only; Know the procedure in the case of accidental spillage and to report accidents; Check that the seal of any storage bag is unbroken when movement is complete; Ensure that the origin of the waste is clearly marked on the bag and appropriately labelled in accordance with EWC; Understand the special problems related to sharps disposal;
Waste management training is offered to all staff when attending induction and annual mandatory infection control updates.
Personal Protective Equipment & Avoidance of Injury People who handle the filled bags requiring disposal should be made aware of the hazards of handling hazardous waste. •
People who are repeatedly moving bags from one small receptacle to a large container may become complacent with the routine activity. Risk of injury is therefore increased for those staff handling the waste in large quantities within a relatively short time period when loading the container.
The hazard most likely to endanger health is injury through a sharp such as a hypodermic needle which may have been wrongly disposed of into a bag instead of the correct sharps container.
When moving sacks hold them by the closure end only and wear heavy duty gloves to protect the hands. Gloves should also be worn when handling sharps containers.
To protect the feet against bags or containers that might be accidentally dropped, sturdy shoes should be worn. The soles of such footwear will also offer protection in the storage areas where the spillage of sharps must be guarded against. 15
Avoid body contact with bags of clinical waste. If there is the slightest risk of brushing against clothing when being transferred then an industrial apron or leg protectors will need to be worn.
Careful consideration must be given by all staff to the methods used for transferring waste at all stages of the disposal route, so that the risk of injury is reduced to a minimum.
Where there is a risk of contamination with blood or body fluids cleaning up spillage protective clothing must be used. This will include visor or mask and goggles, disposable gloves and disposable apron/overall. When an accident occurs involving sharps or contamination of blood or body fluids, however small, it must be reported to the immediate Line Manager. If possible retain the item causing the injury to help in the identification of the risk.
A course of anti-tetanus/Hepatitis B vaccine should be offered by occupational health for all operatives carrying out waste transfer to the final disposal or collection point within Health Centre.
Management of Spillages – Bagged Clinical Waste Disposable gloves and aprons must be worn. (Personal Protective Equipment) Dust pan and brush must be used to minimise contact. The contaminated area must be wiped with hypochlorite 1000 part per million (ppm) available chlorine using paper towels. If there is visible blood a 10,000 ppm available chlorine must be used. The spillage must be re bagged, in a new yellow clinical sack. Gloves, aprons, paper towels must be disposed of in a clinical sack. Decontaminate hands following removal of personal protective equipment. The dust pan and brush must be washed in hot water and detergent after use.
Management of Sharps Waste Spillages Personal Protective Equipment - Disposal gloves and aprons must be worn. A new container must be used, ensure correctly assembled and labelled. The Sharps container must be placed in a larger Sharps box. Dust pan and brush or tweezers must be used to minimise contact and reduce risk of injury. Wipe the contaminated area with hypochlorite 1,000 ppm available chlorine using paper towels. If evidence of visible blood use hypochlorite 10,000 ppm available chlorine. Gloves, aprons, paper towels must be disposed of as clinical waste. Decontaminate hands following removal of personal protective equipment.
Incidents/Accidents All staff have a responsibility to report incidents/accidents involving waste following the PCT incident reporting procedure. Near misses should also be reported eg needle found in a clinical waste bag but no injury caused to the handler of the waste.
References Environment and Sustainability Health Technical Memorandum 07 â€“ 01 : Safe Management of Healthcare Waste 2006 Department of Health Environment Agency 2003 Hazardous Waste Interpretation of the definition and classification of hazardous waste. Environment Agency Bristol Environmental Protection (Duty of Care) Regulations 1991 SI 1991 No 2839 Health and Safety at Work ect Act 1974 SI 1974/1439 The Stationery Office 1974 ISBN 011 141439 X Infection at work: Controlling the risks, produced by the Advisory Committee on Dangerous Pathogens and published on Health and Safety Executive (HSE) website. Management of Health and Safety at Work. Management of Health and Safety of Work Regulations 1999. Approved Code of Practice and guidance L21 (second edition) HSE Books 2000 ISBN 07176 2488 9 Manual handling. Manual Handling Operations Regulations 1992. Guidance on Regulations L23 (second edition) HSE Books 1998 ISBN 07176 2415 3 Manual handling in the health services 12481
1998 HSE Books ISBN 07176
The Carriage of Dangerous Goods and Use of Transportable Pressure Equipment Regulations 2004 SI 2004 No 568 The Controlled Waste Regulations 1992 SI 1992 No 588 The Control of Substances Hazardous to Health Regulations 2002. (as amended). Approved Code of Practice and Guidance L5 (Fifth edition) HSE 2005 ISBN 07176 2981 3 The Environmental Protection Act 1990 (C43) The Hazardous Waste (England and Wales) Regulations 2005 SI 2005 No 894 The Personal Protective Equipment at Work Regulations 1992 SI 1992 No 2966 The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995: Guidance for employers in the healthcare sector Health Services Information Sheet HSIS! HSE Books 1998. Workplace health, safety and welfare. Workplace (Health, Safety and Welfare) Regulations 1992. Approved Code of Practice L24 HSE Books 1992 ISBN 07176 0413 6
Appendix A European Waste Catalogue European Waste Catalogue Chapters Chapter Number
Production sector/Origin of Waste
Wastes from exploration, mining and quarrying, physical and chemical treatment of minerals.
Waste from agriculture, horticulture. Aquaculture, forestry, hunting and fishing, food preparation and processing.
Wastes from wood processing and the production of panels and furniture, pulp, paper and cardboard.
Wastes from the leather, fur and textile industries.
Wastes from petroleum refining, natural gas purification and pyrolytic treatment of coal.
Waste from inorganic chemical processes.
Waste from organic chemical processes.
Wastes from the manufacture, formulation, supply and uses of coatings (paints, varnishes and vitreous enamels), adhesives, sealants and printing inks.
Wastes from the photographic industry.
Wastes from thermal processes.
Wastes from chemical surface treatment and coating of metals and other materials, nonferrous hydrometallurgy.
Wastes from shaping and physical and mechanical surface treatment of metals and plastics.
Oil wastes and wastes of liquid fuels.
Waste organic solvents, refrigerants and propellants.
Waste packaging, absorbents, wiping clothes, filter materials and protective clothing not otherwise specified.
End of life vehicles from different means of
Production sector/Origin of Waste transport and vehicle maintenance.
Construction and demolition wastes.
Wastes from human or animal healthcare and/or related research.
Wastes from waste management facilities, off-site waste water treatment plants and the preparation of water intended for human consumption and water for industrial use.
Municipal waste (household waste and other similar commercial, industrial and institutional wastes (including separately collected fractions).